By VINCE KURAITIS, GIRISH MURALIDHARAN & JODY RANCK
This entry is Part 2 of half 3 of three within the collection Platforming Healthcare — The Lengthy View. This essay is the subsequent within the collection entitled “Platforming Healthcare — the Lengthy View”. The collection presents a 30-12 months Framework for Platforming Healthcare. An up to date v2.0 of a graphic depicting this 30-12 months Framework is proven above.
At this time’s publish is part 2 and can proceed to explain and talk about a possible successor to the EHR period — Unified Digital Well being Platforms (UDHPs). Right here’s an summary:
Mayo Clinic Platform
Enterprise and Strategic Implications of UDHPs
APPENDIX: Further Readings on UDHPs
Mayo Clinic Platform: Healthcare platforms and AI
The Mayo Clinic Platform (MCP)was launched a number of years in the past with the objective of constructing the longer term Mayo Clinic enterprise mannequin that would transfer past the bricks-and-mortar strategy to conventional healthcare and open up new avenues for services and products. The adoption of a platform enterprise mannequin was thought-about important to serving sufferers past the normal Mayo Clinic geography in addition to a technique to incentivize innovation in AI and decentralized care within the house.
A big longitudinal database with each structured and unstructured information offers a basis for the MCP, notably in respect to catalyzing innovation in medical purposes of AI. The database referred to as Mayo Clinic Platform Uncover has over 7.3 million de-identified affected person information that can be utilized for coaching AI fashions in addition to in analysis and discovery for early-stage startups specifically who want to be part of the MCP ecosystem. The dataset is known as “Information behind glass” for the privateness and safety requirements which are wanted to create the bedrock for a collaborative ecosystem.
Supply: Mayo Clinic Platform Playbook
MCP is a three-sided market that has resolution builders, information suppliers, and clinicians composing the three sides. MCP acts because the orchestrator of the ecosystem and extra companions comparable to Mercy have joined as information contributors within the MCP element referred to as Mayo Clinic Platform Join. These are the first parts of the platform.
The Mayo Clinic Platform Playbook identifies six key success components:
A privacy-protecting, safe collaborative setting with de-identified information from international sources. Longitudinal databases of affected person information are very important to medical analysis and the event of latest medical decision-support instruments, therapeutics, and digital well being options. Privateness and safety should be maintained to guard the belief of Mayo Clinic’s sufferers.
Breadth and depth of affected person information have to be adequate to generate insights for each uncommon and customary illnesses.
Seamless capabilities to each ingest various information sources (e.g. -omic (genome, metabolome, and so forth.), EHR, wearables, social determinants of well being (SDoH)) and to ship actionable insights on the level of care.
Chopping-edge information science analytic instruments, sturdy computing energy, and uniform information requirements.
Sturdy governance to imagine safety, scientific validity, interoperability and validation of applied sciences match for goal.
Pathways for commercialization of efficient, validated options.
MCP vets startups and extra mature expertise distributors by a course of that may start with offering entry to the longitudinal database for creating and coaching fashions (early-stage startups) to scaling options throughout MCP and affiliated hospitals with Mayo Clinic. The sturdy governance construction and integration with MCP makes scaling into different methods rather more possible.
AI governance is a core element of the MCP and why they have been one of many unique sponsors of the Coalition for Well being AI (CHAI) to convey collectively main business gamers to create the requirements for accountable AI throughout validation, explainability, and transparency. Guaranteeing that AI instruments have been rigorously validated is important for clinician adoption of AI in addition to sustaining the belief of sufferers. These requirements act as a form of “guidelines of the street” for expertise resolution suppliers on the MCP.
MCP makes use of ServiceNow’s Utility Portfolio Administration (APM) resolution that permits customers to create a complete stock of all purposes utilized by an organization. Many well being methods wrestle to take care of the buildup of purposes over time and this creates safety points, redundancies, and dangers to hospitals. The APM resolution facilitates integration of utility portfolios with clearer traces for possession, duty for upkeep and decommissioning, and administrative roles.
For MCP any such resolution affords a myriad of benefits when orchestrating an ecosystem of expertise distributors and purposes which are built-in with Mayo Clinic’s digital infrastructure (EHRs, pathology and radiology purposes, and so forth.) and past when the MCP companions with each expertise distributors on their platform and exterior hospitals and methods.
The problem of sustaining belief in a UDHP is appreciable. Within the MCP case, one can discover expertise options that may have a platform enterprise mannequin that engages with a number of different expertise distributors. This creates a “platform of platforms” state of affairs with appreciable complexity and may carry with it cybersecurity dangers if collaborators of those exterior platforms have safety vulnerabilities or challenges with interoperability. Due to this fact a rigorous vetting course of with requirements for not solely validation of AI fashions however inclusive of integration into the MCP community.
UDHPs will reshape many aggressive dynamics of healthcare.
A Platform Shift – Disrupting EHRs?
Within the short- to medium-term, UDHPs will probably be complementary to EHRs. EHRs are deeply entrenched in at present’s healthcare supply methods.
However as famous earlier, the roots of at present’s EHRs are as methods of file to doc claims submissions. To be truthful, Epic, Oracle, and different EHRs are trying to maneuver past their historic slender scope.
However, the long-term prize is to turn into the system of motion that automates interoperability, information sharing, and workflows inside and throughout healthcare organizations. The BOI Technique Playbook depicts the basic platform shift:
Well being interoperability guru Brendan Keeler has famous that it most likely gained’t be one other EHR that displaces Epic:
Disruptive software program change for B2B SaaS takes many years throughout all industries for enterprise dimension purchasers. Significant disruption will not be a pure play competitor however the finish results of a whole platform change (Home windows was disrupted by cellular, not by one other PC OS or antitrust). What disrupts an incumbent EHR gained’t be one other EHR.
Oracle’s new, subsequent era EHR needs to be characterised extra as a UDHP than as a standard EHR. Writing in Cloud Wars, Bob Evans makes a case for Oracle’s technique:
… the bromide about how “what obtained you right here gained’t get you there” will present a stark instance of why area of interest suppliers that dominated the on-prem world will probably be overmatched and pushed to the periphery within the trendy world of cloud and AI. Larry Ellison has dedicated the total sources of his total firm to making sure that Oracle Well being can deal with not solely EHRs and adjoining segments but in addition the complete $16-trillion healthcare business….Oracle has been coping with all the things from software program integration to huge international deployments to complicated governance points for the world’s largest and most-complex organizations for greater than 30 years.
EHRs probably gained’t go away, however they’re susceptible to turning into commoditized because the value-creation and value-capture alternative shifts towards UDHPs.
UDHPs Allow New Ecosystems & Strategic Partnerships
Whereas non-public well being methods are probably early clients, UDHPs might be adopted by or prolonged to many different sectors or subsectors of healthcare. Let’s contemplate some examples:
Consulting agency Zühlke described how UDHPs might be deployed by life sciences corporations.
As a result of life sciences corporations… aren’t tech corporations, they may normally need to contemplate licensing a digital well being expertise platform within the type of a platform as a service (PaaS). This allows them to sidestep a number of the complexity of constructing their very own platform and give attention to their core enterprise.
Salesforce described how its UDHP providing is appropriate for Med Tech corporations.
Many MedTech corporations depend on a number of expertise methods that weren’t designed with buyer engagement or the power to work with one another in thoughts. It’s important to combine this right into a unified expertise. A single platform that’s simple to handle, can develop with your corporation, and may combine with present information and homegrown methods can energy your group extra successfully.
Authorities organizations are candidates for UDHP adoption. An Australian public hospital system deployed ServiceNow’s UDHP.
Higher’s UDHP is the underlying expertise supporting the OneLondon shared care planning resolution throughout the town of London. The “end-of-life Common Care Plan (UCP) – is supporting a inhabitants of roughly 10m folks, throughout 5 Built-in Care Programs, over 40 NHS trusts, and 1,400 normal practices.”
A report for the Norwegian Directorate of e-health illustrates how a UDHP might transcend EHRs to allow a broader digital care supply system:
Lastly, we see the potential for the creation and adoption of UDHPs that cater to notably massive and/or complicated subsectors of healthcare supply. Medical imaging is one instance the place a UDHP could be deployed by an imaging middle, a big radiology group, and even inside a well being system. In line with NetApp, “medical imaging contains 90% of medical information [storage] worldwide.“ Of the over 1,000 FDA-authorized AI medical gadget algorithms, roughly 75% relate to medical imaging.
AI Will Play a Main Position in UDHP Adoption
Whereas we foresee that AI will play a key function in UDHP adoption and implementation, the specifics are unclear and up for grabs. We anticipate that over time AI will probably be embedded in each layer of healthcare IT and will probably be utilized to a variety of administrative and medical workflows – each inside and throughout organizations.
An instance – up to now, there have been large battles over consumer interfaces:
Within the Eighties – the GUI warfare between Apple and Microsoft
Within the Nineties – browser wars between Netscape Navigator and Microsoft Web Explorer.
Within the 2000s – telephone working system wars amongst a dozen contenders resulted in large wins for Apple iOS and Android
One other consumer interface battle is shaping up for clinician mindshare. AI will play a significant function.
At this time’s EHRs are famend for his or her poor UI and UX. EHR incumbents are scurrying to construct extra user-friendly AI interfaces. Epic has 125 AI-enabled options which are stay or in improvement.
UDHPs themselves can compete with EHRs by incorporating extra user-friendly AI interfaces. UDHPs will provide low code/no code instruments to handle workflow and processes throughout care groups.
Might a startup digital well being firm create a novel AI interface layer on high of EHRs?
As famous in TechCrunch, “the interface is the place the revenue is.” We are able to anticipate the battle…however anticipating the winner(s) is way more durable.
UDHPs Allow Platform Enterprise Fashions
Incumbent healthcare organizations can prolong UDHP technological infrastructure to reconceptualize themselves as having platform enterprise fashions. SAP makes the case that “the longer term hospital is a platform.”
Mayo Clinic has been a poster baby for modern pondering with its Mayo Clinic platform. Dr. Gianrico Farrugia, President and CEO at Mayo Clinic, described Mayo’s transition from a standard pipeline enterprise mannequin to an modern platform mannequin:
Our present healthcare mannequin capabilities as a pipeline, which is linear, extremely transactional, and rigid. The failings of this mannequin have been clear throughout the pandemic, the place collaboration was restricted and stress to particular person nodes led to factors of failure. This, in flip, hampered and in some instances paralyzed the complete system.
A platform mannequin of well being care and ecosystem is basically totally different. A platform is constructed round safe, collective sources comparable to a robust analytic engine and an open ecosystem of trusted collaborators and is very dynamic, self-learning, inherently accessible, and scalable. This strategy brings collectively suppliers, medical gadget corporations, well being tech startups, sufferers, and payers, amongst others, to design built-in end-to-end options which are supported by longitudinal medical information and AI algorithms. A platform is purposefully collaborative and fuels innovation and entry as an alternative of limiting it.
UDHPs Advance the Motion Towards Cloud (CIO POV)
Throughout industries, the IT panorama is experiencing a major shift in the direction of cloud computing. Organizations are more and more adopting multi-cloud and hybrid cloud methods to optimize operations, improve flexibility, and scale back vendor lock-in. This development is pushed by the necessity for scalability, cost-efficiency, and entry to superior providers like AI and analytics.
UDHPs align strongly with the cloud computing development by leveraging its scalability, flexibility, and accessibility. Cloud infrastructure permits UDHPs to combine disparate methods, facilitate information sharing, and assist modern purposes.
Lengthy-Time period Potential for Winner(s)-Take-All?
At the moment there are 20+ UDHPs. This market has many long-term traits of a extremely concentrated, winner(s)-take-all market. By “extremely concentrated”, we imply a monopoly (one dominant agency), a duopoly (two dominant companies), or an oligopoly (a small group of dominant companies — sometimes three to 5):
UDHP consumers will choose to “single house”, i.e., choose a single UDHP platform
Switching prices will probably be very excessive
Community results will probably be robust
We foresee the UDHP market as turning into a battle for purposes and builders. Builders choose to work on as few platforms as attainable, ideally one or two.
UDHPs thus could have robust oblique community results. Consumers will choose UDHPs that supply a variety of purposes created by builders; builders will converge on platforms which have the best variety of consumers.
The smartphone working system (OS) market offers an analogy. In 2006, there have been 12 corporations providing smartphone OSs; by 2015, the battle was over — Android and Apple iOS owned greater than 99% of the market. At this time these winners every boast over 2 million apps on their OS platforms.
Implications: Because the UDHP market turns into extra concentrated, there will probably be a couple of winners and lots of losers. Consumers ought to consider distributors fastidiously.
Unified Digital Well being Platforms are a brand new class of enterprise software program, one which Gartner predicts “will, over time, substitute the dominant period of the monolithic digital well being file (EHR).”
At this time, the UDHP market continues to be very early – about 5% penetrated.
UDHPs provide compelling worth propositions – bettering medical care, overcoming the restrictions of EHRs, providing modular architectures, enabling a typical infrastructure, and offering aggressive benefit.
UDHPs additionally promise to shake up the aggressive panorama of healthcare by creating a significant platform shift. Within the quick time period, they need to collaborate with EHRs; in the long run, they’ll commoditize EHRs. They allow new platform enterprise fashions and facilitate the event of latest ecosystems and partnerships.
UDHPs will play a significant function within the broader “platforming” of healthcare. They’re a development value watching.
Vince Kuraitis JD/MBA is an impartial guide with over 35 years’ expertise throughout 150+ healthcare & tech corporations. He publishes The Healthcare Platform Weblog, the place this publish first appeared.
Girish Muralidharan was an SVP at GE Healthcare till April 2024 and held a wide range of Government enterprise administration roles throughout Imaging tools, tech enabled providers, digital platforms & options over the past 2 many years.
Dr. Jody Ranck is a researcher with over 30 years of expertise in international and home US well being expertise and coated AI, information analytics, and SDoH with Chilmark Analysis.
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